Date of Award

January 2015

Document Type

Open Access Thesis

Degree Name

Doctor of Nursing Practice (DNP)


Yale University School of Nursing

First Advisor

Mark Lazenby


Background: There is a well-established link between health and education (Bundy and Guyatt 1996). An efficient and cost effective way to increase access to care is through school-based services.

Methods: The purpose of this study is to develop a sustainable staffing model of a school-based health center in a country with limited health care resources. Two specific steps towards developing such a model are: (1) to critically review and analyze the evidence in the literature supporting an expanded nursing care practice model for the school-based health center, and (2) to merge the literature review findings with participatory field notes taken at a rural Kenyan school.

An integrative review was triangulated with observational field notes. Online databases were reviewed. Data from 17 articles was compiled into a summary table. Field notes and transcriptions of recordings were categorized by the following themes: identified stakeholders, local health needs, local health practice, and local health services. The findings from the review were triangulated with the findings from participatory field notes of informal discussions and governmental documents.

Results: The findings suggest equivalent outcomes between nurse-led care and physician-led care. Stakeholder involvement is key to addressing potential barriers. From these findings, a nurse-staffed, school-based health center model was developed, focusing on the nurse as the care provider. The nurse-staffing model identifies key institutional and governmental influences and their impact on the ability to achieve the goal of providing affordable, accessible, and acceptable quality health care for students in rural, under-resourced areas.

Conclusion: The evidence from the review supports the nurse-staffed, school-based health center model and deems it an effective strategy for offering high quality, cost effective care to children in under resourced areas.


This is an Open Access Thesis.

Open Access

This Article is Open Access